"Coming Out” Against Cancer: Increasing Rural Nurse Practitioner Students’ Awareness Regarding Clinical Cancer Screening in LGBTQ+

The origin of cancer health disparities and mortality in Arkansas is multifactorial. In response to a cooperative agreement with the National Cancer Institute's Center to Reduce Cancer Health Disparities, the Arkansas Special Populations Access Network (ASPAN) was developed to reduce these disparities. ASPAN's partnership with local primary care physicians of the Arkansas Medical, Dental, and Pharmaceutical Association through the Cancer Education Awareness Program is the focus of this article. A quasi-experimental intervention, the Community Cancer Education Awareness Program, was employed that included 1) physician education to increase awareness of risk factors and cancer screening; and 2) patient education to increase screening, and 3) patient-generated screening questionnaires to prompt discussion of cancer risk and screening recommendations between patients and physicians. Two urban and 2 rural clinics were targeted during a 12-month period with interval intervention assessments. Baseline review of records (n = 200) from patients >/=40 were utilized to assess the rate of breast, prostate, and colorectal screenings among clinics. For the patient education intervention, patients (n = 120) were interviewed via a 34-item assessment. Physician awareness of cancer risk factors and screening recommendations significantly increased. Statistically significant increases were seen for prostate (P = .028), breast (P = .036), and colorectal (P < .001) cancer screening across all 4 clinics. Patients' increased likelihood of cancer screenings was associated with knowledge about consumption of animal fat (P < .001), dietary fiber (P < .013), and mammograms (P < .001). Utilizing the physician as the central change agent, the ASPAN provider network successfully enhanced cancer screening awareness of minority physicians and their patients. Cancer 2006. (c) 2006 American Cancer Society.

BackgroundPhysician recommendations for cancer screening and prevention are associated with patient compliance. However, time constraints may limit physicians’ ability to provide all recommended preventive services, especially with increasing demand from the Affordable Care Act in the United States. Team-based practice that includes advanced practice registered nurses and physician assistants (APRN/PA) may help meet this demand. This study investigates the relationship between an APRN/PA visit and receipt of guideline-consistent cancer screening and prevention recommendations.MethodsData from the 2010 National Health Interview Survey were analyzed with multivariate logistic regression to assess provider type seen and receipt of guideline-consistent cancer screening and prevention recommendations (n = 26,716).ResultsIn adjusted analyses, women who saw a primary care physician (PCP) and an APRN/PA or a PCP without an APRN/PA in the past 12 months were more likely to be compliant with cervical and breast cancer screening guidelines than women who did not see a PCP or APRN/PA (all p < 0.0001 for provider type). Women and men who saw a PCP and an APRN/PA or a PCP without an APRN/PA were also more likely to receive guideline consistent colorectal cancer screening and advice to quit smoking and participate in physical activity than women and men who did not see a PCP or APRN/PA (all p < 0.01 for provider type).ConclusionsSeeing a PCP alone, or in conjunction with an APRN/PA is associated with patient receipt of guideline-consistent cancer prevention and screening recommendations. Integrating APRN/PA into primary care may assist with the delivery of cancer prevention and screening services. More intervention research efforts are needed to explore how APRN/PA will be best able to increase cancer screening, HPV vaccination, and receipt of behavioral counseling, especially during this era of healthcare reform.

Background: Early cancer detection is widely recommended to reduce cancer mortality, for cancer is most successfully treated during the early stage. In Maryland, only 44.6% of all cancers are detected at the early stage, which may partially account for the fact that blacks in Baltimore City experience significantly higher mortality rates related to breast, cervical, and colorectal cancers. Access to cancer screening and early detection services and early education are critical in reducing cancer mortality and disparities. Past studies have examined the factors that influence cancer-screening behaviors, however, few have directly assessed how the association between knowledge and behavioral intentions relative to cancer screening varies with age. Methods: The data was collected from the Advancing Community Outreach Study (March 2014-June 2015) conducted by the Johns Hopkins Center to Reduce Cancer Disparities in collaboration with community partners in Baltimore City. The data was obtained via convenience sampling at health fairs and community presentations, and study participants (n=294) responded to various questions to assess knowledge, attitudes, and behavioral intentions based on past and future communications with a health care provider about screening for breast, cervical, and colorectal cancers. Cancer knowledge focused on screening methods and National Cancer Institute's recommendations for screening. The primary outcome measure was defined by behavioral intentions indicated by the participant. Results: Preliminary analyses showed that the study population was 83.1% female and 88.5% black. Individuals were separated into three age groups (&amp;lt;50, 50-59, and &amp;gt;60 years of age) to examine the association between cancer screening knowledge and behaviors/intentions. Significant differences in knowledge of cervical cancer (p=0.030) and colorectal cancer (p&amp;lt;0.000) screening guidelines by age group were noted. Past actions related to getting cancer screening varied with age as well. After adjusting for differences in age, gender, and race, positive associations were found between knowledge of cervical cancer screening guidelines and past actions (OR, 3.4; 95% CI, 1.5-7.7) as well as between knowledge of colorectal cancer screening guidelines and past actions (OR, 4.2; 95% CI, 1.7-10.2). Stratifying by age groups indicated that individuals under 50 with knowledge of cervical cancer screening guidelines had higher odds of having positive intentions (OR, 3.6; 95% CI, 1.1-12.3) and positive past actions (OR, 11.1; 95% CI, 1.8-66.3). A positive association was also found in individuals over 60 with knowledge of colorectal cancer screening guidelines, for they had higher odds of both positive health intentions (OR, 5.2; 95% CI, 1.0-27.3) and past actions (OR, 6.7; 95% CI, 1.2-38.3). Knowledge of breast, cervical, and colorectal cancer screening methods was high across the study population (% individuals with correct knowledge &amp;gt;92.0 in all knowledge questions) and showed non-significant differences by age group. Conclusions: Study findings suggest that individuals closer in age to a specific cancer screening guideline demonstrate a positive association between cancer screening knowledge and behavioral intentions linked to obtaining cancer screening. The findings highlight the importance of increasing early and consistent education about cancer screenings to encourage early detection of cancer and to ultimately reduce the disparity in cancer mortality rates. Further research should be conducted to explore the additional factors that influence knowledge of cancer screening methods and guidelines and how that level of knowledge affects cancer screening behaviors. Citation Format: Anjani D. Kapadia, Ahmed Elmi, Lee Bone, Caryn Bell, Saad Tussaduq, Theron Scott, Olive Mbah, Adrian Dobs. The effect of knowledge on cancer screening intentions and behaviors among African Americans. [abstract]. In: Proceedings of the Eighth AACR Conference on The Science of Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; Nov 13-16, 2015; Atlanta, GA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2016;25(3 Suppl):Abstract nr B71.

Screening and Surveillance Colonoscopy and COVID-19: Avoiding More Casualties

Background The lesbian, gay, bisexual, and queer/questioning (LGBQ) population, also referred to as sexual and gender minorities (SGM), is a medically underserved and understudied population in the United States. Literature has argued that, as of recent years, there are a limited number of early cancer detection and prevention guidelines catered specifically to LGBTQ+ community, which creates a gap in access to healthcare services for this population. Furthermore, there are potential barriers that exist for LGBT people, such as discrimination from healthcare providers and other societal constraints which could further contribute to the lack of screening for cancer. The purpose of this study is to explore the knowledge, attitudes, and individual experiences of LGBQ individuals regarding cancer prevention, screening, and treatment to develop educational material that would help cater the needs of this population Methods This study consisted of a series of structured qualitative interviews facilitated as focal groups. The interview guideline contained questions regarding the domains of knowledge, attitudes, and individuals experiences on cancer screening in SGM. The recruitment process was facilitated via online flyers in social media platforms and through local community organizations that provide services for the Puerto Rican SGM population. Participants that reached out were screened for eligibility based on age and self-identified gender and sexual orientation. The focal groups have been carried out via a video teleconferencing software to limit contact with participants considering COVID-19. The interviews have been recorded and transcribed ad-verbatim for analysis purposes. Thematic analysis with open ended coding is being used to analyze the data obtained. Results A total of 8 participants completed the informed consent and proceeded to participate in the focal groups. The cervical cancer focal group consisted of 4 participants who identified as lesbian, bisexual, and non-binary women. 2 self-identified gay men of prostate cancer focal group and the colorectal cancer focal group included 3 gay men. As analysis was carried out, the following recurring themes were identified: Treatment knowledge, Treatment limitations, General recommendations regarding Healthcare services, Social limitations for Healthcare services, Experiences on Healthcare settings. Discussion Preliminary analysis exposes participants exhibited a general lack of knowledge regarding cervical, prostate, and colorectal cancer symptomatology and screening procedures. In the case of the Cervical Cancer focus group, participants agreed their general experience in healthcare settings could be improved by educating healthcare providers on being more inclusive with the LGBTQ community and adjusting the healthcare setting to be less heterocentric. The participants in the focal groups for Prostate Cancer and Colorectal Cancer, on the other hand, stated that the approach should be directed towards educating the LGTTQ+ community on cancer symptomatology and cancer screening practices. Citation Format: Gabriela López Toledo, German J. Rivera Castellar, Elmer Marrero, Marta M. Sánchez Aracil, Mirza J. Rivera Lugo. Knowledge and attitudes of a sample of Latinx LGBQ population regarding cancer screening, prevention, and barriers: An exploratory study [abstract]. In: Proceedings of the AACR Virtual Conference: 14th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2021 Oct 6-8. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2022;31(1 Suppl):Abstract nr PO-256.

Screening For Colorectal Cancer in the Age of Simulation Models: A Historical Lens

Cancer screenings in Louisiana (LA) have been consistently lower than the national average. Sexual and gender minorities (SGM) are more likely to be non-compliant with cancer screening guidelines and consistently do not meet cancer screening recommendations. This study compares compliance to cervical, breast, and colorectal cancer (CRC) screening guidelines over time between SGM and the non-SGM population in LA. Data were obtained from the LA 2014, 2016, 2018, 2020, and 2022 Behavioral Risk Factor Surveillance System (BRFSS). The sample was divided into gay (including lesbian, gay, bisexual, or other sexual orientation other than straight) and straight. Three primary outcomes of interest were used to measure breast, cervical, and CRC cancer screening adherence based on the U.S. Preventive Services Task Force (USPSTF) screening recommendation at the time of each survey. Descriptive analysis and chi-square tests were conducted using sample weights. CRC had the lowest compliance rate in the entire population and across sexual orientation groups. Twenty-five percent of both populations had never received any CRC screening test. Comparatively, 3.6% of straight and 5.3% of gay populations had never received a mammogram while 6.6% of straight and 13.6% of the population had never received a pap smear. Significant improvements in compliance to breast, cervical, and CRC cancer screenings guidelines was observed among those who identified as straight over the survey years until 2020. Decreases in screening compliance were observed in this population from 2020 to 2022, likely due to the effects of the COVID pandemic. Screening compliance in those who identified as gay showed more variation over time in all three cancers. Screening compliance for CRC and cervical cancer were at its highest in 2016, declined to its lowest point in 2020, but increased in 2022. In 2016, there was a significant decline in breast cancer screening compliance in this population to the lowest ever observed in both groups. The initial increases in colorectal and cervical cancer screening observed from 2014 to 2016 among the gay population may be attributed to significant decreases in uninsured rates following the passage of the Affordable Care Act. Additionally, this population saw increased access to the private insurance market following the Obergefell decision and the Marriage Equality Act of 2015, which extended employer-sponsored coverage to same-sex couples. While breast cancer screenings declined from 2014-2016 in the gay population, there was a sharp increase from 2016 to 2018, which aligns with the 2016 expansion of Medicaid in Louisiana. Despite increases in access to insurance coverage, SGM individuals report being in fair or poor health and having negative experiences with healthcare providers at higher rates than their non-SGM counterparts. More research is needed to understand the healthcare landscape and experiences of SGM Louisianans. This will help to inform targeted interventions to increase screenings and improve cancer outcomes among this population. Citation Format: Bilikisu Elewonibi, Carleigh Baudoin, Ashely Fenton. Cancer screening trends in Louisiana’s sexual gender minority population [abstract]. In: Proceedings of the 17th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2024 Sep 21-24; Los Angeles, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2024;33(9 Suppl):Abstract nr A126.

Cancer Prevention in a Postpandemic World: A One-Stop-Shop Approach

Background: Cervical cancer is the leading cause of cancer-related death in Haiti yet the country does not provide sufficient screening. Working class women in Haiti are less likely to receive cancer screening or education than the poorest quartile of women. This is an untouched demographic not necessarily because of financial burdens but because most women work 6 days weekly and lack the time to seek healthcare and appropriate screening. Innovating Health International (IHI) and Share Hope recently implemented a cancer screening program using vaginal HPV self-swabs and clinical breast exams for working class women in Port-au-Prince. Aim: To not only bring much needed cervical cancer education, screening and treatment to an unreached demographic but also to assess the plausibility and acceptance by female factory workers to receive routine screening and treatment in clinics that reside within the workplace. Methods: The project began in September 2017 and will run for 12 months with plans to screen 4000 women with vaginal HPV swabs (QIAGEN careHPV) and clinical breast exams. Nurses perform clinical breast exam, teach self-breast exam, and instruct patients how to perform vaginal self-swab in the factory infirmary. Inclusion criteria for women include age 30 to 50 years. Women who screen positive for HPV will then be followed with visual inspection of the cervix with acetic acid (VIA) and thermocoagulation. Those who have suspicious masses in their breast have a breast ultrasound performed at the factory clinic. A smaller percentage of women with advanced disease will be referred to outside gynecology clinics. Results: Data collection is half-way completed and we´ll present full data in October. Over 3122 women have participated and received education on women's health issues during their lunch hour at the factories. Of all those sensitized, 2691 or 86.1% chose to have clinical breast exam. Of those who are eligible for HPV screening, 1948 or 93.8% of those eligible accepted testing. Of those tested, 344 or 16% were HPV-positive and all but a 5 completed VIA. For women who are HPV-positive, 69 or 20% were also VIA positive. All HPV-positive women received thermocoagulation except for 2, who were referred for colposcopy and loop electrocautery excisional procedure. There were 141 women who had a positive clinical breast exam and underwent breast ultrasound with only 2 requiring a biopsy. Conclusion: We seek to expand access to cervical cancer screening for the rural and working poor through using mobile health technologies coupled with community-based education and screening. HPV-positive women can undergo treatment by a traveling nurse with portable thermocoagulation therapy where they live or work, without the need to travel or leave work. With no doctor, no electricity, no pelvic exam for most women, and no stable infrastructure, we can screen women in rural areas and the working poor at their place of employment.

The rising incidence of skin cancer continues to be a significant public health concern in the United States. Nurse practitioners (NPs) have a key role in early detection of skin cancer. However, NP students currently demonstrate low levels of knowledge related to skin cancer assessments and recognition of skin lesions. The aim of this pilot study was to determine if simulations with standardized patients wearing three-dimensional (3D) prosthetic skin lesions improved NP students' knowledge, self-confidence, and observed simulation performance with regard to assessing, diagnosing, and managing patients with nonmalignant versus malignant skin lesions. A quasi-experimental approach was used with a convenience sample of 39 NP students. Students participated in three consecutive simulations, each followed by a debriefing. Performance was assessed during the simulations using a rubric. Knowledge and self-confidence were measured immediately before and after the simulation. Correct responses on knowledge items increased for 14 of the 18 items. Self-confidence significantly improved from pretest to posttest. There was a statistically significant improvement in performance from the first to third simulation encounter. Simulation with standardized patients wearing 3D lesions can enhance NP students' knowledge, self-confidence, and performance of skin cancer assessments. Nurse practitioner programs can consider using simulation to prepare students for dermatologic care and to help improve the probability of early detection of skin cancer in various health care settings.

Telehealth is becoming increasingly integral in providing improved access to care, especially for patients who reside in frontier and rural areas. Nurse practitioner (NP) faculty are charged with preparing NP students through curriculum and clinical experiences that align with the health care environment and the health care access needs of the populations they serve. To meet this need, NP faculty at a land-grant university located in a frontier and rural midwestern state reinforced NP student telehealth curriculum and competency through application in a clinical environment. Participants included 22 family NP (FNP) students and 19 clinical preceptors. According to the evaluations, the FNP students met seven of the eight competency criteria, and the preceptors met eight of the 13 evaluation criteria. Outcomes indicate telehealth curriculum competency can be reinforced through application in a clinical setting to prepare NP students to meet the needs of patients and changing health care environments. [J Nurs Educ. 2020;59(7):413-417.].

BackgroundFor more than two decades, integration of team-based approaches in primary care, including physicians, advanced practice registered nurses and physician assistants (APRN/PA), have been recommended for improving healthcare delivery, yet little is known about their roles in cancer screening and prevention. This study aims to review the current literature on the participation and roles of APRN/PAs in providing cancer screening and prevention recommendations in primary care settings in the United States.MethodsWe searched MEDLINE and CINAHL to identify studies published in 1990–2011 reporting on cervical, breast, and colorectal cancer screening and smoking cessation, diet, and physical activity recommendations by APRN/PAs in the United States. A total of 15 studies met all of our eligibility criteria. Key study, provider, and patient characteristics were abstracted as were findings about APRN/PA recommendations for screening and prevention.ResultsMost studies were cross-sectional, showed results from within a single city or state, had relatively small sample sizes, reported non-standardized outcome measures. Few studies reported any patient characteristics. APRN/PAs are involved in recommending cancer screening and prevention, although we found variation across screening tests and health behavior recommendations.ConclusionsAdditional research on the cancer prevention and screening practices of APRN/PAs in primary care settings using standardized outcome measures in relation to evidence-based guidelines may help strengthen primary care delivery in the United States.

109 Background: The COVID-19 pandemic has disrupted medical care in all areas of the US and had a profound impact on cancer screening, with a concern that this may lead to excess cancer-related deaths over the next decade. There are existing disparities in cancer mortality among rural US residents and Native Hawaiians (NHs) due to access issues, lower socioeconomic status and lack of a sufficient provider workforce. A reduction in cancer screening may therefore have an oversized impact on these populations. In this study, we examine the effects of the COVID-19 pandemic on cancer screening frequency among NHs and in urban and rural populations in Hawaii. Methods: De-identified data on the frequencies of breast cancer (BCS), cervical cancer (CCS) and colorectal cancer (CRCS) screenings for 2019 and 2020 were obtained for Hawaii residents from several sources, including Hawaii Medical Services Association, the largest private and Medicaid provider in Hawaii, and the two largest state-wide health systems, Queen’s Health Systems and Hawaii Pacific Health. Data was analyzed using Rural-Urban Continuum Codes (RUCC) and Rural-Urban Commuting Area (RUCA) codes to define rurality and, along with health system facility location, to ascertain whether there was a differential impact on cancer screening rates for rural populations due to the pandemic. Cancer screening data for NHs in comparison to other groups was analyzed separately. Results: Overall, reductions in cancer screening during the pandemic were seen, with the degree of reduction varying widely across regions of the state and among different ethnic populations. Annual reductions in BCS, CCS and CRCS ranged from 4.0-30.2%, 2.7-3.0% and 9.4-13.2%, respectively, depending on the data source. BCS reductions were greatest in rural areas (p = 0.09) and among NHs (p = 0.0005). The island of Kauai, which is rural but was minimally affected by COVID-19, saw no reduction in BCS. CCS reductions had a reverse urban vs. rural pattern, with reductions of 4.5% urban and 0.8% rural (p = 0.02). CRCS reductions were most profound in rural residents (17.1%; p = 0.0001); reductions in CRCS among NHs were 1.5x greater than other groups. The differential impact across urban and rural areas was consistent for both RUCC and RUCA analysis. The extent of reduction was most significant for CRCS and was directly proportional to the degree of rurality. Conclusions: BCS and CRCS were impacted more significantly by the COVID-19 pandemic than CCS. For BCS and CRCS, greater reductions were seen in rural compaed to urban populations and in NHs. The lack of correlation with rurality for CCS may be because this population is generally younger and screening is often provided as a component of primary care. The greater pandemic-related reduction in screening among rural residents and Native Hawaiians may exacerbate existing cancer mortality disparities in these vulnerable populations.

We examined rural-urban differences in the prevalence of cancer risk factors and screening behaviors across U.S. census regions to better understand variations within and between geographic regions and inform strategies to address rural cancer inequities. Using an ecological cross-sectional design, we examined rural-urban differences in the self-reported prevalence of county-level cancer risk factors (i.e., obesity, physical inactivity, alcohol consumption) and cancer screening behaviors (i.e., breast, colorectal and cervical) ascertained from the Behavioral Risk Factor Surveillance System and National Health Interview Survey (2008-2013) across four U.S. census regions (Northeast, Midwest, South, and West). County-level rurality was defined using 2013 U.S. Office of Management and Budget rural-urban classification codes, and the U.S. Department of Agriculture, Economic Research Service’s rural-urban continuum codes. Chi-square tests assessed differences in the mean prevalence of county-level cancer risk factors and cancer screening behaviors in each geographic region. Analysis of variance (ANOVA) models estimated the p-values for trends in cancer risk factors and screening prevalence across the rural-urban continuum. Within each geographic region, rural counties had a higher prevalence of smoking, obesity and physical inactivity. Yet, rural-urban differences in cancer risk factors were not statistically significant in all geographic regions (e.g., prevalence of obesity for Western rural vs. urban counties was 26.5% vs. 25.7% [p=0.08] and physical inactivity for Northeastern rural vs. urban counties was 23.2% vs. 22.5% [p=0.15]). Moreover, the mean prevalence of obesity was higher in urban areas of the Midwest (31%) and South (31.3%) compared to rural areas in the West (26.5%) and Northeast (29.5%). Binge alcohol use was higher in rural vs. urban counties in the West (19.8% vs. 17.7%; p&amp;lt;0.001) and Midwest (22.3% vs. 21.5%; p=0.006), but lower in the South (13.5% vs. 15.2%; p&amp;lt;0.001). Obesity and smoking prevalence increased with increasing rurality across all regions (ptrend&amp;lt;0.045). Breast, cervical and colorectal cancer screening prevalence were lower in rural vs. urban counties in each geographic region (all p-values&amp;lt;0.04). However, the overall prevalence of screening across all cancer sites was higher in rural Northeast counties compared to both rural and urban counties in the South and West regions. Across all regions, cervical and breast cancer screening decreased with increasing rurality (all ptrend&amp;lt;0.001). A significant inverse trend in prevalence of colorectal cancer screening with increasing rurality was observed in all regions except the Northeast (ptrend=0.17). Our findings suggest notable variations in rural-urban cancer risk factors and screening disparities across U.S. geographic regions. Further exploration of the source of this geographic variation is warranted to ensure the development and implementation of relevant cancer control interventions targeting rural populations most in need. Citation Format: Kelly A. Hirko, Huiwen Xu, Laura Q. Rogers, Michelle Y. Martin, Siddhartha Roy, Kimberly M. Kelly, Shannon M. Christy, Kimlin Tam Ashing, Jean C. Yi, Marquita W. Lewis-Thames, Cathy D. Meade, Qian Lu, Clement K. Gwede, Rachel M. Ceballos, Usha Menon, Katie Cueva, Karen Yeary, Lisa Klesges, Monica L. Baskin, Kassandra I. Alcaraz, Sabrina Ford. Rural-urban disparities in cancer risk factors and screening by United States census region [abstract]. In: Proceedings of the 16th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2023 Sep 29-Oct 2;Orlando, FL. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2023;32(12 Suppl):Abstract nr B053.

Panel 3: Speaker 2